Why do pharmacists detest Medicaid customers?

October 8, 2009

Everyone seems to realize that when the lady being a pain in the neck carries a Gucci handbag, she's someone who helps pay the pharmacy's bills. Not so many people seem to realize that this is equally true of the lady carrying the Medicaid card.

Let's talk about the most open secret in our profession: Pharmacists hate Medicaid customers. There are questions I'd like to ask you about this. It's not every pharmacist and not every Medicaid customer, of course, but if you've worked in retail pharmacy for more than a few days, you've heard:

"I'm a clerk at a Walgreens, and I hate Medi-Cal. I can't stand it."

I found those statements after only a few minutes of searching the pharmacy blogosphere, and they're typical of what many in the profession will say - when the Medicaid customer is out of earshot, that is. We've probably been saying such things since the first Medicaid card was issued in 1965.

My question is why? The most common answer usually comes from those who see themselves as guardians of taxpayer dollars. It's all about waste and abuse they'll say, and about people getting things they don't deserve.

Meet Richard L. Scott. He was the CEO of the health-facility operator Columbia/HCA when the company pleaded guilty to charges that it defrauded Medicare and Medicaid; it settled by paying $1.7 billion dollars. That's way more than any Medicaid customer has ever milked out of the system.

Scott was ousted by Columbia/HCA for his role in the biggest healthcare fraud in U.S. history. Yet, I would be willing to bet that when he picks up prescriptions he gets treated with more respect than the average Medicaid customer. Today, Scott heads a lobbying effort that insists two pillars of any proposed healthcare reform must be "responsibility" and "accountability." I am not making that up.

Now read an article by Atul Gawande in the June 1 issue of The New Yorker. In it he details how the city of McAllen, Texas, has gone from an average per-capita Medicaid spending rate in 1992 to the second-highest rate in the nation today, with no evidence of increase in the quality of care. He makes a solid case that it's because local doctors have developed a culture that encourages gaming the system. If you work in a pharmacy in McAllen, and you're talking behind the backs of your Medicaid customers, are you also talking behind the backs of the physicians in your community, the ones who seem to be driving up costs for us all? If not, why? Another reason we cite for dissatisfaction with Medicaid people has to do with the pain-in-the-neck factor. Medicaid people are somehow hard to deal with; they cause problems and frustrations.

I have worked in stores where more than 80 percent of the prescriptions were paid for by Medicaid, and I have worked in some of the most affluent areas in the country. I assure you, neither end of the economic spectrum has a shortage of problem customers.

Everyone seems to realize, though, that when the lady being a pain in the neck carries a Gucci handbag, she's someone who helps pay the pharmacy's bills. Not so many people seem to realize this about the lady with the Medicaid card. I've heard plenty of disrespectful comments directed toward Medicaid customers, but it's not very often I've heard someone offer to give up the revenue they bring in - or the part of their paycheck funded by Medicaid dollars. Again, my question is why? Long ago it stopped being acceptable to judge people solely by their race, their religion, or their gender. In most places, not so long ago, it stopped being acceptable to judge people by their sexual orientation. Why do so many of us who claim to be in a "caring profession" find it perfectly normal to judge individuals on no other basis than their insurance coverage?

Take a good look in the mirror and ask yourself why. Answer honestly.

David Stanley is a practicing community pharmacist in California. He can be reached at drugmonkeyrph@gmail.com
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